Body dissatisfaction and muscle dysmorphia are rising among adolescent males, and the majority of boys in the U.S. (nearly 60%) report altering their diet in pursuit of muscularity. Propelling them along their dangerous pursuit of muscularity is the dietary supplements industry, which targets boys and young men with deceptive disinformation about its sometimes dangerous products. Muscle-building supplements and the culture surrounding them are causing serious damage to kids' mental and physical health, and will only continue to wreak havoc if left unchecked.
The supplements industry can and must be stopped.
"I heard I should take a pre-workout protein shake to build muscle faster, which I've been doing every day, but my body isn't changing. What else should I take?" Pediatricians, coaches, and parents are hearing questions like this more and much too often from teen boys.
Sadly, teens feel increasing pressure to strive for the extreme muscularity they see in Hollywood heroes or the 2 million plus #mensfitness posts on Instagram. What's more, the internalization of the muscular ideal has shown to be directly related to depressive symptoms and low self-esteem in adolescents. This is particularly alarming when coupled with the current mental health crisis teens face in the U.S.
More than half of teen boys (55%) and 33% of teen girls use protein powders. It's not much of a surprise to see these high numbers when muscle-building supplements are so easy for teens to buy at local stores, gyms, and online. That, coupled with the relentless and deceptive marketing of muscle-building supplements has led to high rates of use among adolescents.
This is deeply concerning given that it is widely known that many unscrupulous manufacturers lace their products with illicit steroids, excessive stimulants, and experimental drugs not approved for human use. As recently as April of this year, the FDA came out with another strong warning about the widespread problem of muscle-building supplements illegally laced with selective androgen receptor modulators (SARMs). SARMs act similarly to testosterone and anabolic steroids and are linked with elevated risk of heart attack, stroke, liver injury and failure, psychosis, testicular shrinkage, and erectile dysfunction. The FDA particularly calls out influencers and vendors on social media who target teens with their false promises and deceptive messaging leading young people to mistakenly believe the products are safe and healthful.
As a pediatrician (Vargas), the concern is more than statistics: This is real life for the boys and young men I care for -- and the stakes for them are high.
I met a 10-year-old boy who, after hearing from older kids at camp that he needed to build muscle if he wanted to be a good athlete, changed his diet by cutting out fats and adding protein. As his rigid food restrictions and nutrition worsened, his heart rate plummeted to 35 beats per minute. He ultimately needed to be admitted to the hospital to stay safe while undergoing nutritional rehabilitation.
A high school senior I met had been using protein supplements since middle school and now has signs of kidney injury on his blood tests. He is currently being evaluated by specialists to hopefully prevent the long-term kidney damage caused by these products.
Few teens, or parents, realize that use of muscle-building supplements comes with serious risks. I see and treat too many teens who have added protein supplements to their daily routines, often using them multiple times a day. Some have developed muscle dysmorphic disorder, a serious mental health condition, and more and more boys these days feel they don't measure up if they aren't hypermuscular.
Protein powder use in adolescence can also serve as a gateway to later steroid use. A recent study found teen boys who used protein powders were twice as likely as other boys to start using illicit anabolic steroids or other similar dangerous substances as young adults. The findings for girls were even scarier: Girls who used protein powders as teens were five times as likely as other girls to start using steroids or other similar substances.
Unfortunately, the companies that sell these products crank out so many false and misleading claims that many kids -- and parents -- fall for the deception. But even leading authorities, from the American Academy of Pediatrics to the National Athletic Trainers' Association, strongly caution against youth, athletes, and consumers of any age using these products.
Given the weight of the evidence and the consensus among medical and sports authorities that these products are harmful for kids, many might rightly wonder how these products could still be legal to sell to children.
Hopefully, this will soon change in New York and Massachusetts, thanks to proposed legislation that would prohibit the sale of dangerous over-the-counter supplements for muscle building to minors.
But like Big Tobacco, the deep-pocketed supplements industry is flooding statehouses with their lobbyists sowing lies and confusion about their products to keep lawmakers from acting. In response in both states, pediatricians, parents, and youth advocates are joining forces to put pressure on lawmakers to push back against a relentless industry that profits from the body insecurities of teens. The voices of pediatricians speaking out about the harm done to young people will be vital to bolstering protections for children from these predatory products. The time has come for necessary and commonsense action by lawmakers: Put people before profits and keep these dangerous supplements out of kids' hands.
Gabriela Vargas, MD, MPH, is instructor of pediatrics at Harvard Medical School and attending physician in the Division of Adolescent and Young Adult Medicine at Boston Children's Hospital. She is also the director of the Young Men's Health Site and on the board of directors of the Partnership for Male Youth. S. Bryn Austin, ScD, is professor of social and behavioral sciences at the Harvard T.H. Chan School of Public Health and director of the Strategic Training Initiative for the Prevention of Eating Disorders.